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SITE ADDRESS <br />�.G�a� 7-l� � /�v� <br />LEGAL LOT NO. <br />DESC. 'ZN t'Z� <br />OWNER <br />1�N�N ���, <br />PERMIT APPL►'CATION <br />CITY OF EVERETT PF!cMIT SERVICES <br />3200 CEDAR STREE i, EVERE7T, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIOP;S ARE ACCEPTED FROM 8 AM TO 4 PM �— !�'i --�b <br />���,-�1t� ►��9 <br />BLOCK <br />� �_ <br />I� U. �TcK ?� <br />Uo <br />r� <br />PARCEL TAX I.D. # PE IT # <br />� ��a��z�zvh� C�"�ol -i7 <br />OR SUODIVISION # �t <br />"vt��l i.J � Ac�cli1'iGti �u �'ve�ei/ (/q�.7 �<ye3`> <br />/'ic,(�Yf(/iII��W%�..���%U ��2Si%O-IG��S� <br />7ENANT NnlAE T CONTACT FOR PERMIT PHONE L.�'!,f ^}%7C'�S� J <br />�� � rz��!4/4 n <br />Y[rGf E-MAILVTI?Z'Gvi74I5' �%%T�� � <br />CONTRACTOR ADDH S CINIZIP - —NT�Nr <br />��.r,r -r--,���t�,�yti LLL, c'I`-�% I/a���,�, y�.. <br />CONTR. LICENSE it <br />_(�TRINL'F9��3F G��<,��o r.,itiff 9r�'�_�z ���--3�7-5)��I <br />USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br />�- �� , r� _ �i Gas __ Olher � Z �/ U�' G <br />2 Lr � �� �� �, Electric <br />WOftP U[SCRiP71fIN <br />�%i <br />'��U ���=. <br />1�0. I TYPE OF FIXTURE OR ITEM <br />G� Toilet <br />—� Balhlub <br />_j;� Lavr,lcry (wash basin) <br />Shower <br />Z Kilchen sink 8 disposal <br />� Dishw2sher <br />� Clolhes washer <br />�._ Waler heafer <br />' Sink (servicelbadmopretc.) <br />Backllow preventer <br />Urinal <br />Drinkinc� Fountain <br />Floor dr36t <br />_ Gre � trap _ <br />� Ropf d _ins� /1 F �rY <br />�� t)liinr Ue �:f'Y•i / <br />NO. I NPE OF FIXTURE OR ITEM <br />' A/C - air handling imils <br />Z Forced air syslems <br />S' Gas piping <br />� Waler healer <br />� Gas li;ep!ac,. <br />Z rasrange i� <br />� Cblhes dryer <br />Ranqr hoc3 <br />_ Exhausttai. <br />Heal pump <br />Unit heater <br />Boiler <br />� Refrigeration <br />Woodstove <br />Olher <br />—I <br />� <br />CITY OF EVERETi� LOCAL SALES TAX COCE IS 3105 <br />I hereby cerilify that I have read and examined this application and know the same to be true and correct. All piovisions of law� and <br />ordinaccs 9overninp this lype of work will be complied wilh whell:er specified herein or not. TL+e g; ;ntiny ot a permil does nol pres�me <br />to give a�lhority to violate or cancel the provision of any uther stsi�� cr tocal iaw regulatiny construction or the pedurmance of <br />construclion. Thal I am aulhorized by the owner of inis preperty to perform the work for which 2pplication is made and I comply with the <br />Stale Contractors Law 18.27 RCW and 296.200 WAC. <br />�.�. � �/�� ( — 4Y-v.� <br />'1� <br />